Dorsch Michael P, Lee Jin Sun, Lynch Donald R, Dunn Steven P, Rodgers Jo E, Schwartz Todd, Colby Emily, Montague Debbie, Smyth Susan S
Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, USA.
Ann Pharmacother. 2007 May;41(5):737-41. doi: 10.1345/aph.1H621. Epub 2007 Apr 24.
Aspirin therapy is a cornerstone in the prevention of atherothrombotic events, but recurrent vascular events are estimated to occur in 8-18% of patients taking aspirin for secondary prevention after 2 years. Estimates of biologic aspirin resistance vary from 5% to 60%, depending on the assay used. However, the relationship between biologic measurements of aspirin resistance and adverse clinical events remains unclear.
To determine whether patients with documented myocardial infarction (MI) while on aspirin therapy (cases) were more likely to be aspirin resistant than were patients with coronary artery disease (CAD) who had no history of MI (controls) and to assess clinical predictors of aspirin resistance in patients with stable CAD.
This case-control study examined aspirin responses using the VerifyNow Aspirin Assay system in 50 cases and 50 controls who had taken a dose of aspirin within 48 hours of presentation to the clinic visit. Odds ratios were estimated to determine the association between aspirin resistance and MI. Independent predictors of aspirin resistance were determined using univariate and multivariate analyses.
An increase in the prevalence of aspirin resistance among cases (16% vs 12% in controls) was not observed (OR 1.40; 95% CI 0.45 to 4.37; p = 0.566). In the overall CAD population, female sex was independently associated with aspirin resistance (OR 4.01; 95% CI 1.15 to 13.92; p = 0.029).
Additional large studies are required to understand whether biologically defined aspirin resistance is associated with increased risk for cardiovascular events, with special attention paid to sex differences.
阿司匹林治疗是预防动脉粥样硬化血栓形成事件的基石，但据估计，在接受阿司匹林二级预防治疗的患者中，2年后有8% - 18%会发生复发性血管事件。根据所使用的检测方法不同，生物学上阿司匹林抵抗的估计值在5%至60%之间。然而，阿司匹林抵抗的生物学检测结果与不良临床事件之间的关系仍不明确。
确定正在接受阿司匹林治疗的有心肌梗死（MI）记录的患者（病例组）比没有MI病史的冠状动脉疾病（CAD）患者（对照组）更有可能出现阿司匹林抵抗，并评估稳定型CAD患者中阿司匹林抵抗的临床预测因素。
这项病例对照研究使用VerifyNow阿司匹林检测系统，对50例病例和50例对照进行了阿司匹林反应检测，这些患者在就诊前48小时内服用过一剂阿司匹林。通过估计比值比来确定阿司匹林抵抗与MI之间的关联。使用单因素和多因素分析确定阿司匹林抵抗的独立预测因素。
未观察到病例组中阿司匹林抵抗患病率的增加（病例组为16%，对照组为12%）（比值比1.40；95%置信区间0.45至4.37；p = 0.566）。在整个CAD人群中，女性性别与阿司匹林抵抗独立相关（比值比4.01；95%置信区间1.15至13.92；p = 0.029）。
需要更多大型研究来了解生物学定义的阿司匹林抵抗是否与心血管事件风险增加相关，尤其要关注性别差异。
